The GRADE system provides a structured approach to grading the quality of evidence and strength of recommendations in clinical guidelines. It aims to improve the clarity and consistency of evidence-based decision-making in healthcare. The system considers factors such as study design, quality, consistency, and directness of evidence. Evidence quality is categorized as high, moderate, low, or very low, while the strength of recommendations is determined by the balance between benefits and harms. The system also considers the cost-effectiveness of interventions and the applicability of recommendations to specific patient groups and settings. The GRADE system helps users of clinical guidelines assess the confidence they can place in recommendations. It provides a systematic approach to making complex judgments about the quality of evidence and the strength of recommendations. The system is designed to be simple and clear, allowing for consistent judgments across a wide range of interventions and contexts. The system includes a sequential process for developing guidelines, starting with establishing the process, followed by systematic reviews, preparation of evidence profiles, grading of evidence quality and recommendation strength, and implementation and evaluation. The quality of evidence is judged based on the results of systematic reviews, considering factors such as study design, quality, consistency, and directness. The strength of recommendations is determined by the balance between benefits and harms, as well as the cost-effectiveness of interventions. The GRADE system also addresses the ethical responsibilities of researchers in clinical trials. It proposes an ethical framework to help delineate researchers' responsibilities in providing ancillary care to participants. Ancillary care is defined as care that is not required to make a study scientifically valid, to ensure a trial's safety, or to redress research injuries. Researchers have a duty to provide ancillary care when it is necessary to ensure the well-being of participants, even if it is not stipulated in the trial's protocol.The GRADE system provides a structured approach to grading the quality of evidence and strength of recommendations in clinical guidelines. It aims to improve the clarity and consistency of evidence-based decision-making in healthcare. The system considers factors such as study design, quality, consistency, and directness of evidence. Evidence quality is categorized as high, moderate, low, or very low, while the strength of recommendations is determined by the balance between benefits and harms. The system also considers the cost-effectiveness of interventions and the applicability of recommendations to specific patient groups and settings. The GRADE system helps users of clinical guidelines assess the confidence they can place in recommendations. It provides a systematic approach to making complex judgments about the quality of evidence and the strength of recommendations. The system is designed to be simple and clear, allowing for consistent judgments across a wide range of interventions and contexts. The system includes a sequential process for developing guidelines, starting with establishing the process, followed by systematic reviews, preparation of evidence profiles, grading of evidence quality and recommendation strength, and implementation and evaluation. The quality of evidence is judged based on the results of systematic reviews, considering factors such as study design, quality, consistency, and directness. The strength of recommendations is determined by the balance between benefits and harms, as well as the cost-effectiveness of interventions. The GRADE system also addresses the ethical responsibilities of researchers in clinical trials. It proposes an ethical framework to help delineate researchers' responsibilities in providing ancillary care to participants. Ancillary care is defined as care that is not required to make a study scientifically valid, to ensure a trial's safety, or to redress research injuries. Researchers have a duty to provide ancillary care when it is necessary to ensure the well-being of participants, even if it is not stipulated in the trial's protocol.